Glucagon-like peptide 1 (GLP-1) receptor agonists, such as Ozempic (semaglutide) and Trulicity (dulaglutide), are increasingly used to manage type 2 diabetes and, in some cases, for weight loss. However, the safety of these medications during pregnancy remains uncertain. Due to mixed research findings, experts advise women to temporarily stop or delay starting GLP-1 medications if they are pregnant or trying to conceive.
“More studies are needed to determine if taking semaglutide or other GLP-1s during pregnancy is safe,” says Dr. Monte Swarup, an OB/GYN at Women’s Health Arizona in Phoenix. “Because of that, we ask patients to stop the meds prior to attempting pregnancy, and not to use them during pregnancy.”
Research on GLP-1s and Pregnancy
The first large-scale study on the effects of GLP-1 use during pregnancy was published in the January 2024 issue of JAMA Internal Medicine. This study followed around 50,000 children whose mothers had type 2 diabetes and took either GLP-1s or insulin during early pregnancy. The children were monitored for major birth defects such as cleft palate and congenital hydrocephalus.
The findings indicated that children born to mothers using GLP-1 medications did not have an increased risk of birth defects compared to those whose mothers used insulin. While these results are promising, the researchers emphasized the need for more evidence to rule out potential risks to the fetus from GLP-1s, noting that their study is a preliminary step in understanding how these medications might affect child development.
Another study, published in 2023 in Frontiers in Endocrinology, reviewed 39 studies on the effects of GLP-1 agonists and SGLT2 inhibitors during pregnancy and lactation. It found that GLP-1 use might affect fetal weight and growth, often through reducing maternal weight gain and food consumption. The researchers suggested avoiding these medications during pregnancy. However, only seven of the reviewed studies involved humans, collectively including just 76 children.
“Despite the wide uptake of these novel glucose-lowering medications in clinical practice, information regarding the safety of GLP-1 agonists and SGLT2 inhibitors during pregnancy and lactation is exceedingly scarce,” the researchers concluded.
Risks of GLP-1s During Pregnancy
Based on current research, Dr. Swarup identifies potential risks of GLP-1 medications to the fetus, including miscarriage, lowered birth weights, and birth defects. These risks seem to stem from the drugs’ effects on maternal food intake, weight gain, and possibly hormones involved in skeletal development. Although these risks have primarily appeared in animal studies, there is enough concern to advise against using these medications during pregnancy, according to the Cleveland Clinic.
“If you’re on a GLP-1 and unexpectedly find out you’re pregnant, available evidence shows minimal risk during the early part of pregnancy,” says Dr. Swarup. However, to exercise caution, health providers typically recommend discontinuing GLP-1 medications and switching to diabetes treatments well-researched for safety during pregnancy.
The American Diabetes Association (ADA) prefers insulin for treating diabetes during pregnancy, including gestational diabetes. Other diabetes drugs like metformin and glyburide are not first-line treatments during pregnancy as they cross the placenta. If you’re on metformin and become pregnant, the ADA advises stopping it by the end of the first trimester.
While tapering off GLP-1 medication is usually necessary to prevent rebound weight gain, it’s recommended to stop immediately if pregnancy occurs, according to Dr. Mir Ali, a bariatric surgeon at Orange Coast Medical Center in Fountain Valley, CA. If you become pregnant while on GLP-1 for diabetes, consult your doctor to ensure the best management for you and your baby.
GLP-1s and Getting Pregnant
If you’re considering pregnancy, Dr. Ali suggests discontinuing GLP-1 medications at least two months before conceiving. The Centers for Disease Control and Prevention (CDC) also recommend preconception steps for women with diabetes, such as adopting a regular exercise routine, avoiding alcohol, consulting with a diabetes educator or dietitian, managing medical conditions, and establishing blood glucose control.
GLP-1s and Breastfeeding
Similar to pregnancy, there isn’t enough research to determine the safety of GLP-1s during breastfeeding, says Dr. Ali. “This medication is not likely to be found in breast milk and not well absorbed by the infant through the gastrointestinal tract,” he explains. “However, the effects have not been studied in humans, and the current recommendation is to avoid these medications while breastfeeding.”
Takeaway
The safety of GLP-1 usage during pregnancy is still uncertain due to limited research. While future studies may prove these medications safe for use during pregnancy, current recommendations advise discontinuing GLP-1s before conception or upon learning of pregnancy. If you’re using a GLP-1 drug for type 2 diabetes, work with your doctor to manage your diabetes safely during pregnancy, ensuring the best outcomes for you and your baby.
